You must be age 18 - 24, have a high school diploma (or equivalent), and meet other eligibility criteria in order to qualify.

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* 1. All items on this form marked with * are required. By clicking "Yes" below, I acknowledge that this information is provided voluntarily for program registration purposes only. The county cannot guarantee all interested individuals will be eligible or selected to participate.

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* 2. First Name

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* 3. Last Name

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* 4. What is your date of birth?

Date

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* 5. Five digit ZIP Code in which you reside:

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* 6. Contact Phone # (no spaces or dashes)

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* 7. Additional Contact Phone # (no spaces or dashes)

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* 8. For identity verification purposes, please provide the last four digits of the registrant's Social Security Number (SSN):

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* 9. Email address at which you can be reached

Essential program communications are transmitted via email. Please ensure an address that can be easily accessed is provided.

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* 10. Do you currently have your high school diploma (or equivalency)?

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* 11. Are you currently working, or are you immediately prepared to work, at least 30 hours per week?

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* 12. If administered today, would you be able to pass a pre-employment drug screening?

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